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#FlintWaterCrisis, Health Information Exchange, and Meaningful Use?

FlintWaterCrisis, UM-Flint Course, North Bank Center

I recently attended a series of presentations at the UM-Flint Department of Public Health and Health Sciences's offering of an innovative course at the North Bank Center (picture above). This course is offered free to the community and to the students for credit. This bi-directional learning opportunity features leaders and experts in the Flint water crisis. On January 28th, Mark Valacak, MPH, Health Officer at the Genesee County Health Department presented the historical timeline of the crisis since 2013 through the present state. A snippet of information on one of the slides caught my attention: "...lead data is in MICR".


If the Lead data was being tracked in the MICR (Michigan Care Improvement Registry), the obvious next question is, why didn't the State of Michigan find it first? Before the local Hurley Hospital pediatrician Dr Mona Hanna-Attisha did? Well, here's the answer, sad as it is: the data was not searchable, or easily accessible, since it was embedded in a lab report as a PDF attachment.

It's a cumbersome process to go digging through each individual medical record, open the attachment, search it manually, and record the statistics. In spite of the advances in computing and information technologies, and compelling reasons to convert the individual health records to electronic format, in this case, the system was found to be inadequate.

A little background on the EHR topic: After the Great Recession in 2008-09, almost $26B (billion) were set aside as part of the American Recovery and Reinvestment Act of 2009 to incentivize physicians and hospitals to transition their records systems to the electronic format. Beginning in 2011, the Electronic Health Records (EHR) Incentive Programs were developed to encourage eligible professionals and hospitals to adopt, implement, upgrade (AIU), and demonstrate meaningful use of certified EHR technology. As a result, hundreds of thousands of physicians and many hospital systems nationwide, have indeed switched over to certified EHR technology. But are they truly using the systems meaningfully? Does the certification of the EHR systems imply true accessibility and exchange of the captured data? Is meaningful use just a buzz word?

The goal of "Meaningful Use" is to help the providers to prescribe, and the community to receive better quality healthcare in a more efficient manner. Sadly, the ongoing #FlintWaterCrisis demonstrates the result of "Meaningless Use" of information technology. There is enough blame to go around. But, as IT solution providers in the healthcare vertical, we need to do better, with respect to true meaningful use and information exchange, if we have any hope of preventing the next health crisis.

Cybersecurity Awareness and Healthcare IT Events

cyber-security awareness month and HIMSS FTC2015
October was a busy month for IT professionals. It was National Cyber-Security Awareness Month (NCSAM), an annual effort to increase awareness of cyber security risks. The National Cyber Security Alliance - a private-public partnership sponsored by the US Govt. Homeland Security, Google, Visa, Verizon, RSA, Microsoft, Facebook, etc. - pursues it's mission to educate and empower a digital society to use the Internet safely and securely at home, work, and school. See here for more information about their mission, goals and partners.
 
On October 22nd, the University of Michigan hosted their annual SUMIT event for 2015 at the Rackam Auditorium on their central campus. 
SUMIT_2015 broke all previous registration records with 899 people registering and 466 attending the event. An additional 260 unique viewers watched the live stream webcast throughout the day. These individuals represented more than 160 universities, corporations, small businesses, and nonprofits from around the country. SUMIT_2015 (Security at UM in IT 2015) keynote speaker Gov. Rick Snyder, said “For everything we do to advancing information technology... it’s equally important that there’s a corresponding effort to encourage better cyber security”. Currently the state of Michigan's government experiences about 2.5 million cyber attacks every day, according to Snyder. He said Michigan has a competitive advantage compared to other regions because of the state’s public universities and colleges, as well as their ability to collaborate with one another. “One, I think there are more attacks, but secondly I think we’re better at recognizing we’re attacked. I think in many cases we were probably being attacked and we didn’t even know it,” he said.
A morning panel discussion on "Privacy, IT Security, and Politics" featured Ari Schwartz, former special assistant to the president and White House senior director for cybersecurity, and David Sobel, senior counsel at the Electronic Frontier Foundation.
An afternoon panel on "Advanced Persistent Threats" featured Tom Winterhalter, supervisor for the FBI Detroit Division's cyber squad; Jen Miller-Osborn, cyber threat intelligence analyst, Palo Alto Networks; Colonel Jon Brickey, Army Cyber Institute Partner Relations director for the national capital region; and Randy Hegarty, enterprise security IT manager, CISO Office, Penn State University.  During the panel discussion, Jen Miller-Osborn said that the education sector is the third most victimized sector in the country for cyber attacks for both student data and research.
Snyder urged attendees to take action on the issue, citing as one example the Civilian Cyber Corps, a new organization composed of citizens willing to collaborate with one another if Michigan were to experience a broad attack. Snyder foresees the organization as a precursor to a long-term solution which he hopes will eventually be a specialty team within the National Guard.
 
Cybersecurity was also a topic of conversations and presentations at the 3 day HIMSS Fall Technology Conference held on Oct 25-27 at the Detroit Marriott in the Renaissance Center in downtown Detroit. Although mainly focussed on Healthcare IT in general, this event's topics dovetailed nicely with the CyberSecurity concerns of securing and protecting Big Data in healthcare. At any HIMSS event, interoperability is front and center; no surprise there. The event had significant representation from large regional health systems like Henry Ford, DMC, and Beaumont, but it was surprising that tthe payor community participation was lacking. It would seem that they (BCBS, HealthPlus, Humana, United Healthcare, etc) would be very much present in the conversations and discussions at an event like this. Maybe they were busy at other events.
 
In the Big Data space, it is clear that Hadoop is the dB of choice for extracting knowledge and value out of the data tsunami in healthcare.
Practically all exhibitors at the conference touted their wares in the Big Data Analytics space. For Big Data Analytics and IT solutions, if you are a relatively smaller entity, it is ok to have vendors that are value based. But if you are a large healthcare delivery system, you will want to stick with the big name integrators and systems providers like IBM, Oracle, Microsoft, etc. Makes sense, to reduce risk. Nothing personal, just business.
 
As expected, many talks and presentations focused on the standards and efforts to improve interoperability. Tim Pletcher, Exec. Director of Michigan Health Information Network (MiHIN), the state level shared services provider, presented the creation of an Interoperability Accelerator and Conformance Testbed to drive faster adoption and pursuit of healthcare information exchange. A cool effort was the random patient data set generator, to test interoperability use cases, without using actual patient data sets. A significant chanllenge continues to be the search for a fool-proof, definitive master patient identifier. For those up for a challenge, here's an incentive  The College of Healthcare Information Management Executives (CHIME), the healthcare industry’s professional organization for chief information officers and senior IT executives, is calling on innovators throughout the U.S. and around the world to participate in the CHIME National Patient ID Challenge. The award of the Hero X-Prize is worth a million dollars.
 
Specifically FHIR (Fast Healthcare Interoperability Resources, pronounced 'fire') caught a lot of buzz, with many panelists and speakers presenting their efforts into making use of this new standard. Dr Robert Chang of the University of Michigan  presented a use case of FHIR in clinical research. FHIR is a new interoperability standard from HL7, purposed to make it easier to exchange all healthcare data in a simple and secure manner. Using the concept of 'resources' (chunks of data that make sense in the healthcare environment, like Patient, Condition, Medication, Procedure, etc), FHIR has the ability to be extended to meet specific use cases. This allows the core resources to remain small and manageable, and still expand to meet any new requirement.
 
Bottom line: FHIR has caught fire, and it's adoption will grow quickly. Better get familiar with it, fast!

Salesforce enters healthcare vertical

It was just a matter of time. Finally, early last month, Salesforce.com took the wraps off their new target industry: the Healthcare vertical. Salesforce claims they like to "think about this as precision healthcare." Its called, plainly enough, Health Cloud. The announcement confirmed recent persistent rumors about its intentions to break into the healthcare market. The software-as-a-service suite features "patient relationship management" tools – distinct from the current EHRs. In a pre-release statement to a news publication, Salesforce chief medical officer Dr. Joshua Newman said, "We think we are among the pioneers in the post-EHR world".

Newman noted that Salesforce did not simply wake up one day and decide it wanted a nice slice of the $3 trillion healthcare pie. Rather, Salesforce is leveraging a comprehensive ecosystem of partners in the development and deployment of Salesforce Health Cloud. Healthcare companies Centura Health, DJO Global, Radboud University Medical Center and UCSF assisted with product design and feature development; and other partners offer integrations to leading EMRs from Epic, Cerner and GE; industry partner Philips provides integrated medical device connectivity and new applications for connected and continuous care; and systems integrators deliver services for implementation, integration, customization and content.

Through the Health Cloud platform, Salesforce joins a growing crop of companies that offer more comprehensive views of patient data than electronic health records. Precision medicine is a grand vision that everyone is pursuing. But it won't happen quickly, not on a large scale, despite President Obama's backing of the Precision Medicine Initiative.

Precision medicine strives to incorporate genomics, bioinformatics and other cutting-edge uses of data to tailor individually-specific treatment regiments. In contrast, Dr Newman says precision healthcare is about "managing patients and not records". Health Cloud integrates data from a variety of sources, including EHRs, medical devices and wearables, among others, that care coordinators and clinicians can view in a modern social network-style dashboard interface.

Notable features include Timeline, which enables providers to see the patient's health journey, and the Patient Caregiver Map, which helps clinicians track relationships in the patient's household and with doctors and specialists.

Health Cloud's Today function, meanwhile, can alert care coordinators to events such as medication refills or missed appointments and Salesforce Chatter lets caregivers see all internal conversations. Private Patient Communities, meanwhile, help care teams collaborate with each other as well as patients across a variety of devices including tablets and smartphones.

While Salesforce's claim to be a pioneer in the post-EHR world could at some point prove true, it is but one among many making that proclamation.

A cadre of vendors are working on new ways to tie patients together with care teams. Then there are Salesforce's traditional rivals Microsoft, Oracle and SAP.

The common theme: Providing a comprehensive view of patient data in a way that EHRs simply cannot. “Healthcare providers face a significant challenge. To deliver the best patient care possible, they rely on data sitting in multiple systems. These include EMRs, lab systems and imaging applications, often across multiple data centers and in the cloud,” said Ross Mason, founder and vice president of product strategy for MuleSoft, a industry partner of Salesforce in developing Health Cloud. “Connectivity is the key to unlocking this data and making it useful. MuleSoft’s integration platform brings data from these systems into Salesforce with an API-led approach, enabling agility while allowing providers to remain in control of their patients’ information."

Salesforce, until now, lacked a product specifically engineered for hospitals and health systems, Newman explained, adding that the name Health Cloud denotes the new service ranks in Salesforce's highest level of products. "The point here is we're disrupting ourselves," Newman explained. "We've always been horizontal, and now we're focusing on verticals. One of those is healthcare."

If you are part of a healthcare system or an integrated care delivery network like an ACO (accountable Care Organization) or OSC (Organized Systems of Care), and are interested in learning more about Salesforce implementation for your organization, pls call us at 810-730-3234. We'd love to help you meet your objectives.

Are you a "Digital Doctor", Doc?

Are you a Digital Doctor, Doc?

As consumers (patients and physicians) get more and more comfortable with the use of health related apps on their smart phone or tablet, it has led to the creation of a tsunami of new apps developed specifically targeting this market segment. In spite of Google search, it is a challenge to find useful information with respect to which of these "revolutionary" apps are really meaningful in delivering better care to the patients. (One can make an argument that the ease of a Google search actually makes it very difficult to seperate the meaningful information from useless data. But that's a topic for another discussion).

That's why this recent article in Internal Medicine News is of immense use. The author, Dr David Lee Scher (MD), a practicing electrophysiologist in Pensylvania, does a great service to physicians in this article. He makes the case for all physicians to embrace the revolution already underway in healthcare, and makes some suggestions for using specific Apps. Here is a link to the online article. Registration may be required for access to full article. Content is copyrighted by internalmedicinenews.com.

Medical Home 2.0?

Here's an infographic from the Advisory Board Company (www.advisory.com) recommending strategies and improvements within your PCMH pracice to strive towards better care delivery, reduced cost and improved consumer/patient satisfaction.

AdvancedMedicalHome infographic

Now that you are a PCMH practice, you need to be thinking about what incremental changes you can make to keep the drive towards the triple-aim alive. You cannot stand still, as you are not at the destination. In fact, you may never reach the destination, and unless you continue to drive costs down and improve the care delivery processes, you will lose out to the competition. And as you well know, healthcare access, convenience, cost and quality are all important aspects of your business that invites a lot of relentless competition. You have to stay a step ahead, adapting and improving your processes to enhance the efficiency and effectiveness. The journey never ends! 

Patient Centered Profit Center

     A recent study (using data from 2013) by MGMA provides encouraging data to support healthcare providers' efforts towards PCMH designation. It can be financially beneficial in the long run. The study was cited recently by familypracticenews.com and internalmedicinenews.com. Do you want some hard evidence that your investments in IT spending and staff training in support of PCMH designation are worth it? This article will provide it. You may need to signup for the free newsletter to access the article.

     PCMH practices spend on average $43 more per patient than non-PCMH practices. But on the positive side, they generate $66 more per patient (after operating costs!) than non-PCMH entities.     

     Be Patient-Centered, and that should help you become a better Profit-Center. What's right for the topline (being patient centric) is also what's right for the bottom line (improved profitability for your practice). SWEET!

EHR Incentive Hardship Application deadline July 1st, 2014

If you are an eligible provider for Medicare, and are not able to successfully attest to the MU requirements, you will want to check out these documents at the CMS.gov site. The first one is a tip sheet for eligible providers who want to apply for hardship exceptions to payment adjustments that will start on Jan 1st, 2015.

The second is the application document and related instructions.

Take time to review these documents and act quickly to submit the application with CMS/Medicare if your situation demands it. It will be time well spent now. After July 1st, 2014, you will lose this opportunity.

Useful medical and health websites for patients

In todays connected world, it's quite a challenge to sort through the information overload and find meanngful and reliable medical and health websites. It is particularly difficult for your patients to make that distinction (credible or not so credible) as they search healthcare information online. Here is a shortlist of reliable websites that you can provide to your patients, if they ask you for some recommendations. (Source: Dr Davis Agus's new book "A Short Guide to a Long Life". The book is currently ranked #5 on the NYT Best Selling Science Books, as of Apr 14, 2014. Dr. Agus (MD) is a professor of medicine and engineering at the University of Southern California and heads USC’s Westside Cancer Center and the Center for Applied Molecular Medicine. He previously authored "The End of Illness"). Here is the list:

  • National Institutes of Health. nih.gov
  • Centers for Disease Control and Prevention. cdc.gov
  • American Academy of Family Physicians. familydoctor.org
  • Office of Disease Prevention and Health Promotion. healthfinder.gov
  • Livestrong.org
  • American Heart Association. americanheart.org
  • The Mayo Clinic. mayoclinic.com
  • National Library of Medicine. medlineplus.gov
  • WebMD.com
  • American Cancer Society. cancer.org

Meaningful Use and EHR Certification in 2014

As you implement certified EHR technology in your practice, and get ready for attestation this year, you will benefit by reading this important blog post by Steven Posnak, Director Federal Policy Division at ONC. Althought this post is dated Sept 2013, it is quite relevant even now. Here is the link.

http://www.healthit.gov/buzz-blog/health-innovation/6-meaningful-ehr-certification-2014/

Be sure to read the pdf link for Eligible Professionals at the bottom of the post. or click here.

Big DATA fallout: How to deal with the disclosure of CMS payments to providers

This has been coming for some time, and it finally happened. So, if you are a provider of Medicare services, you are now left to deal with the "headache" of justifying the amounts to anyone who feels emboldened to ask. You have enough to do as it is. And now this. What do you DO?

Allow me to suggest a couple of approaches. First, don't shy away from the question. This immediately puts the questioner on the defensive, because they realise that you are not only ready to listen to them, but you are prepared to provide a reasoned answer. And you'll be in a stronger position, because the "bully" realises that you are not "scared".  This is the easy part.

Now, for the hard part. Follow up with a well balanced reasoning to state your position. Ofcourse, this requires you to do some work ahead of time. Spend 30 minutes this weekend, and put your thoughts down on paper. You are a well trained, qualified, hard working and experienced healthcare provider. Your services are not "cheap" or "free".

You have staff and employees to pay to run your facility. You have fixed and variable structural costs to deliver the care. Feel free to cite relevant industry statistics and averages to back up your numbers. And don't forget to mention the annual challenges from CMS and private insurance companies to cut reimbursements, that you are already complying with.

Reinforce the quality of care perspective. It is an integral part of payments. You are not only providing a service, but the quality of the service matters. And as everone knows, quality comes at a premium, especially as it relates to one's well-being. As you write these down, no doubt you will come up with more reasons to solidify your position.

The best defense is a well reasoned offense. Don't avoid the argument, take control of it.

Windows XP and HIPAA

Recently, Microsoft announced that they will discontinue support for their "old" operating system Windows XP, beginning April 8th, 2014. Read the following timely summary from Mark Lozen of Structured Technologies to understand how this can affect your practice if you are impacted by this event. Swartz Creek based Structured Technologies is a Solutions Partner of Med IT Systems, in our mission to provide best-in-class IT solutions to our clients.

"Many of you may not be aware, (that) support for Windows XP is coming to a close. Microsoft announced they will no longer provide mainstream support or updates for the Windows XP operating system after April 8th, 2014. This process is generally called "End of Life" or EOL. For those of you using XP on your desktop or laptop, this doesn’t mean it will stop working on that date and you’ll have to upgrade your OS or computer. How it applies to you, and your use of Electronic Medical Records software, is another story.

Part of each of those annoying “Windows Updates” that make you restart your computer, or force you to wait periodically before you can turn off your computer every month or so, involves security. As vulnerabilities to the operating system are found where a hacker or identity thief might exploit them to gain entry into your system, Microsoft makes changes via these updates to keep your data as safe as possible.

When End of Life occurs for XP, Microsoft will no longer be providing these regular security updates. As a result, your computer may become vulnerable to security breaches and you’ll have no easy means to automatically prevent it.

There are three aspects of the HIPAA guidelines that will apply in this situation. Administrative Safeguards (Protection from Malicious Software [Implementation Specification 164.308(a)(5)(ii) (B)], Physical Safeguards [The Workstation Security Standard 164.310(c)], and Technical Safeguards [The Integrity Standard 164.312 (c)(1)].

If your OS is no longer being supported with security updates, how sure are you that the operating system has not been compromised? How do you know if new vulnerabilities will allow unauthorized users access to your ePHI? The answer is that you won’t know how safe your system is any longer and you’re probably, at that point, knowingly operating against best practices as recommended and required by the HIPAA guidelines.

On the April 8th 2014 EOL of Windows XP, your current Windows XP computer will continue to function as it did prior to this date. However to meet HIPAA requirements, you will need to begin updating your systems to a actively supported operating system.

Start planning now on how best to upgrade the devices in your practice or business from Windows XP to Windows 7 or Windows 8. Whether it’s a few devices each month or all at once, you have the time to get it done before it potentially becomes a problem."

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About the author: Adil Mohammed is the co-founder of Med-IT Systems, and blogs on the topic of IT in healthcare, and other issues like privacy/security, coordination of care, and new payment models affecting healthcare professionals. You can checkout his Google+ profile at Google